Provider Demographics
NPI:1124213145
Name:BEVERE, DANIELLE M (RD)
Entity Type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:M
Last Name:BEVERE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 NORTHFIELD AVE
Mailing Address - Street 2:SUITE200
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1198
Mailing Address - Country:US
Mailing Address - Phone:973-736-2212
Mailing Address - Fax:
Practice Address - Street 1:769 NORTHFIELD AVE
Practice Address - Street 2:SUITE200
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1198
Practice Address - Country:US
Practice Address - Phone:973-736-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ805039133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered